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On “Listen” (Summer 2012)

In their article “Hospital, Heal Thyself,” Mollica Manandhar and Paula Buick go far in highlighting subtle interventions that can greatly improve the experience of medical facilities. Design considerations can carefully integrate acoustics, cautious lighting, indoor air quality, and even access and visibility to nature. These elements have shown to be more than experiential improvements but actually integral components to improve health, allowing patients to heal more quickly.

An emerging movement in the design field called “evidence-based design” catalogs many of these interventions and asks that increased research and thought be brought to environmental effects on health and healing. From this movement, suggestions emerge for how interior interventions can go a long way to focus buildings and environments on their direct impact on patients’ and caregivers’ health.

It is, however, only in the last paragraph where Manandhar and Buick touch on the continual vexing problem of this approach. In stating that what is needed is “a holistic approach,” they touch on the real problem with our medical facilities today: byzantine amalgamations of different designs smashed together into an uncomfortable, disparate collection of spaces. These disparate facilities are difficult to navigate, make the administrative structure less transparent and approachable, and elevate the stress of visiting a hospital — all in all, lowering the quality of care. The state of our current medical facilities is the opposite of holistic, and without a complete redesign, important but surface interventions — such as the better carpeting and better infection control that Manandhar and Buick cite — will help but not go far enough to change the way our hospitals and medical spaces can actually help us heal.

Michael Murphy and Alan Ricks
MASS Design Group
Boston/Rwanda


Mollica Manandhar and Paula Buick effectively describe how noisy hospital environments actually harm the health and well-being of patients, families, and staff. From Florence Nightingale to today, they show how noise has become a major health hazard.

As the president and CEO of Rady Children’s Hospital in San Diego for 26 years, I saw firsthand the positive impacts of evidence-based physical design. It is encouraging to see the increasing number of published articles that document the impact of interventions such as larger single-patient rooms, which reduce the incidence of healthcare-acquired infections; wider bathroom doors, which reduce patient falls; appropriate task lighting in medication dispensing areas, which reduces medication-related errors; hydraulic ceiling lifts in patient rooms and bathrooms, which reduce patient and staff lift injuries; and art and music, which reduce anxiety and depression, and speed recovery.

The good news: Hospitals are realizing the importance of negative environmental factors such as noise and clutter. Since 2008, the Centers for Medicare & Medicaid Services (the federal agency that administers Medicare, Medicaid, and the State Children’s Health Insurance Program) has required hospitals to give all Medicare patients the opportunity to complete a Health Care Attitude and Patient Preference Survey about their care experience. Hospitals that are rated higher by patients will do better in the marketplace. This could be a game changer.

Congratulations to the authors for effectively making the case for reducing harm through reducing noise and clutter in healthcare settings. I believe that whether patients are in our care for an hour, a day, a week, or a year, they deserve an optimal healing environment. Increasingly, they are demanding it.

Blair L. Sadler
Institute for Healthcare Improvement
La Jolla, California


ArchitectureBoston’s “Listen” issue was slipped silently into my mail slot. It didn’t beep on my iPad or vibrate on my hip. I flipped through it (a gentle sound, accompanied by pleasant air movement and a distinct aroma) before placing it in my laptop case, where it sat quietly waiting for the weekend. When the time was right, I sat alone in insulated isolation and absorbed its careful contents. Without fanfare, it brought me inside musical instruments, allowed me to eavesdrop on cogent conversations, and alerted me to important information. In a world where competing interests vie constantly to drown one another out, thank you for reminding me of the importance of listening.

Vernon Woodworth AIA
AKF Group
Boston


With so many wonderful things happening at the Boston Society of Architects lately, I now have to add the latest issue of ArchitectureBoston to the list. In her inaugural letter to readers, editor Renée Loth quotes the challenge given to young reporters at The Boston Globe: “Make love to the city every day.” I must say the quality of the learning on offer throughout ArchitectureBoston — the big ideas, the small ideas, the lasting images, the palpable love of places and spaces —  demonstrates a similar commitment. Celebrating such ranging interests is an essential ingredient for stimulating broader interest in architecture. But I’m beginning to wonder if we readers are pulling our fair weight.

In rereading Loth’s comment, I thought about HBO’s The Wire, and how much affection for Baltimore the show instilled in its viewers. I can’t count how many times I’ve recommended that series to friends and acquaintances, many of whose preferences in television drama I know nothing about.

My next thought: Have I ever zealously recommended a read like ArchitectureBoston to friends outside the industry? Why not earmark my favorite selections and place them into new hands to enjoy and consider more fully? It would take me five seconds, and help deplete the stack that forever piles up on my desk from all corners of the country.

After all, how many times have we sat in the lobbies of our offices and seen these publications fanned out across our coffee tables, spines unbroken? Surely, I can be a better ambassador than that. I suspect I’m not alone.

Michael Wood
Association of Architecture Organizations
Chicago


With reference to your recent article on hidden acoustical techniques [“Bring On Da Noise!”], Autodesk was able to deploy a unique technology we affectionately call “pink noise” in our Waltham offices. During project design, there was extensive (and often heated) conversation about the height of the 300 workstations that comprise most of our workspace for our software engineers, marketers, and other staff. Our integrated project delivery team was trying to strike the necessary balance between our desire for open, collaborative space that met LEED daylighting requirements (suggesting very low partitions) versus the need for peace and quiet necessary for the exacting work of software development. Some of our engineers, reminding me that their work was akin to “the hardest math problem you ever did in high school,” suggested that the only solution was to provide offices — with doors.

When Carl Bass, our CEO and a former software developer himself, declared low partitioned workstations as our corporate standard, we looked for other answers. Thus came our “pink noise” system, which is similar to white-noise sound masking, but tuned specifically to the frequencies of the human voice. After extensive computer modeling and work with our acoustic engineers, we installed an advanced audio system with 240 speakers deployed on the three open floors of our office and operated through our digital building management system. In combination with carefully chosen carpet and acoustic treatment for our open-deck ceiling, we’ve created an open, collaborative, but suitably quiet office.

On a recent April Fool’s Day, one of our teams decided to “test” our system — by deactivating it. Within minutes, our staff was distracted by what they thought was some sort of HVAC failure and upon learning of the trick was none too pleased as work came to a noisy halt. Our success in Waltham means that we now use these systems in all new Autodesk offices.

Phil Bernstein FAIA
Autodesk, Inc.
Waltham, Massachusetts


There must be something to this whole “listen” thing. After quickly flipping through ArchitectureBoston’s Summer 2012 issue, I decided to submit my work playlist — songs that get me amped up and one to calm me down —  on architectureboston.com:

1. “Jigsaw Falling Into Place,” Radiohead
2. “Flying Overseas,” Theophilus London
3. “Heavy Vibes,” Vibraphonic
4. “Never Stop,” The Brand New Heavies
5. “Aisha,” John Coltrane

A few minutes later, as if it were fate, a guy who blogs for Herman Miller asked to feature me on their Lifework page (www.hermanmiller.com/lifework/category/balance), talking about my work and my work music playlist — so exciting! Thank you, ArchitectureBoston!

Aisha Densmore-Bey, Assoc. AIA
Boston